Behavior Problems and Social Competence in Fragile X Syndrome: A Systematic Review.

This review looked at 51 studies about behavior and social skills in people with Fragile X syndrome over 20 years. ADHD symptoms were the biggest behavioral challenge. When someone has both Fragile X and autism, they tend to have more behavior problems and greater social difficulties. Family environment and parent factors also affect how children cope. More research is needed to better understand the differences between autism in Fragile X versus autism on its own.

This systematic review examined 51 studies spanning 20 years to understand behavior problems and social competence in Fragile X syndrome (FXS). ADHD symptoms emerged as the most significant behavioral challenge, with overall behavioral problems and social competence remaining stable over the two-decade period. The presence of comorbid autism in individuals with FXS was associated with increased behavioral difficulties and poorer social functioning. Environmental factors and parental characteristics were identified as influential variables affecting both behavioral outcomes and social competence.

The review highlighted methodological inconsistencies across studies and emphasized the need for more rigorous research comparing autism presentations in FXS versus idiopathic autism to better understand the distinct phenotypic profiles.

Clinicians should prioritize ADHD symptom management in FXS and implement enhanced behavioral supports when autism is also present. Family-centered approaches addressing environmental factors and parental characteristics may improve outcomes. More standardized assessment tools are needed for accurate autism diagnosis in FXS populations.

The review identified methodological inconsistencies across the 51 included studies, particularly regarding autism symptomatology assessment and parental characteristics measurement. The socialization trajectory from childhood to adolescence remains unclear, and sample sizes were not consistently reported across studies.

Fragile X syndrome (FXS) causes intellectual disability and is the known leading cause of autism. Common problems in FXS include behavior and social problems. Along with syndromic characteristics and autism comorbidity, environmental factors might influence these difficulties. This systematic review focuses on the last 20 years of studies concerning behavior and social problems in FXS, considering environmental and personal variables that might influence both problems.

Three databases were reviewed, leading to fifty-one studies meeting the inclusion criteria. Attention deficit hyperactivity disorder (ADHD) problems remain the greatest behavior problems, with behavioral problems and social competence being stable during the 20 years. Some developmental trajectories might have changed due to higher methodological control, such as aggressive behavior and attention problems. The socialization trajectory from childhood to adolescence remains unclear.

Comorbidity with autism in individuals with FXS increased behavior problems and worsened social competence profiles. At the same time, comparisons between individuals with comorbid FXS and autism and individuals with autism might help define the comorbid phenotype. Environmental factors and parental characteristics influenced behavior problems and social competence. Higher methodological control is needed in studies including autism symptomatology and parental characteristics.

More studies comparing autism in FXS with idiopathic autism are needed to discern differences between conditions.